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Presentation on theme: "Heuristic Errors in Medicine: The Patient with a Red Eye"— Presentation transcript:

3 History CC: Problem with right eyePI: RJ is a 40 yo female with Downs Syndrome with itching of the right eye for 3 days. She had associated pain in the eye. Her caregiver could not restrain her from rubbing the eye. There was no known history of trauma to the eye. She had no recent URI symptoms.

4 PMH Downs Syndrome – functions as 3 yo Leukemia as a childStroke as result of complication of chemotherapy for leukemiaObesityHypertensionHyperlipidemiaPrimary hypothyroidismSleep apnea

12 PlanUnsure of correct diagnosis, I referred her to an ophthalmologist.

13 Clinical Course Ophthalmologist1. He did eye exam the following morning andprescribed eye drops.2. She returned to see him in 4 days.a. Ophthalmologist was apparently unable to adequate exam.b. With suspicion for underlying pathology, he took her tosurgery for exam under anesthesia and found a cornealperforation.c. Evisceration (not enucleation) procedure was performed.d. Prosthetic ball was placed into scleral husk

14 Later Clinical Course Patient would not leave eye guard in place.The ophthalmologist subsequently removed the ball from the scleral husk.The scleral husk was left in place and will atrophy.

15 QuestionAny ideas as to what was the underlying problem with this patient’s eye?